2025 CPT code 99205
(Revised) Effective Date: N/A Revision Date: N/A Evaluation and Management - Office or Other Outpatient Services Evaluation and Management Feed
New patient office or outpatient visit with high-level medical decision making (MDM) or at least 60 minutes of total time spent on the date of the encounter.
Modifier 25 may be used to indicate a separately identifiable E/M service on the same day as a procedure.
Medical necessity for 99205 must be supported by documentation demonstrating the complexity of the presenting problem and the need for extensive evaluation and management services.
The physician is responsible for obtaining a medically appropriate history and/or performing a physical examination, making high-level medical decisions, and documenting the encounter appropriately.
In simple words: This code covers a visit to the doctor's office or another outpatient setting for a new patient. The visit is complex, requiring significant medical decision-making by the doctor, or it lasts for at least an hour. This includes the time the doctor spends with the patient and the time spent reviewing records and coordinating care, even if it's not done face-to-face with the patient.
Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded. (For services 75 minutes or longer, use prolonged services code 99417)
Example 1: A new patient presents with complex symptoms suggestive of a systemic illness, requiring extensive diagnostic workup and discussion of treatment options., A new patient with a chronic condition requires a comprehensive review of their medical history, current medications, and discussion of ongoing management strategies., A new patient presents with an acute injury requiring immediate evaluation, diagnosis, and development of a treatment plan.
Documentation should include a detailed history, relevant physical exam findings, results of diagnostic tests, complexity of medical decision making, total time spent on the encounter, and a comprehensive treatment plan.
** The information provided is based on guidelines as of December 1, 2024.Always refer to the most current CPT manual and payer guidelines for the most accurate and up-to-date information.
- RVU: The RVU for 99205 varies based on location and is subject to annual updates by CMS. Refer to the latest Physician Fee Schedule for specific RVU values.
- Specialties:This code is commonly used by specialists and primary care physicians in various outpatient settings.
- Place of Service:Office, On Campus-Outpatient Hospital, Off Campus-Outpatient Hospital and other outpatient settings.